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Background: Pulmonary hypertension is defined as resting mean pulmonary artery pressure (MPAP) ≥ 25 mm Hg. MPAP pressure estimation by right-sided heart catheterization (RHC) is considered the gold standard; however, its invasiveness limits repeated and frequent use. The purpose of this study was to compare the accuracy and precision of three echocardiographic methods for estimating MPAP., Methods: We prospectively studied 117 patients with simultaneous RHC and echocardiography. MPAP was calculated by three echocardiographic methods: (1) mean gradient method (adding the right ventricular-right atrial mean systolic gradient to the right atrial pressure), (2) Chemla equation (0.61 × systolic pulmonary artery pressure + 2 mm Hg), and (3) Syyed equation (0.65 × systolic pulmonary artery pressure + 0.55 mm Hg). MPAP calculated by these three methods was compared with that obtained invasively by RHC., Results: The mean ± SD of the differences between invasive MPAP and the three echocardiographic methods were -1.6 ± 7.7 mm Hg for the mean gradient method, -3.7 ± 7.4 mm Hg for the Chemla formula, and -3.2 ± 7.6 mm Hg for the Syyed formula. Median absolute differences were 5.5 mm Hg (mean gradient), 5.7 mm Hg (Chemla; P = .45 vs mean gradient), and 6.0 mm Hg (Syyed; P = .23 vs mean gradient). Accuracy (calculated MPAP within 10 mm Hg of RHC-measured MPAP) was 81% (mean gradient), 77% (Chemla), and 76% (Syyed)., Conclusions: Echocardiographic estimation of MPAP by the mean gradient method had similar accuracy and precision compared with the Chemla and Syyed methods. The acceptable accuracy of these methods suggests that they are equally suitable for clinical use.

Background: The aim of this study was to evaluated an alternative echocardiographic method to calculate mean pulmonary arterial pressure (MPAP)., Methods: One hundred two patients were studied with simultaneous right-heart catheterization (RHC) and echocardiography. MPAP was calculated by adding the right ventricular-right atrial mean systolic gradient to right atrial pressure., Results: The mean difference between MPAP calculated using this method and RHC-derived MPAP was -1.6 mm Hg, less than that of traditional systolic pulmonary arterial pressure (SPAP; -6.4 mm Hg) and MPAP estimated using the pulmonary regurgitation method (-13.9 mm Hg). The median absolute percentage difference of the MPAP calculations relative to RHC was significantly less with this method than with the pulmonary regurgitation method (18% vs 71%; P < .001) and similar to the SPAP method (both 18%; P = .30)., Conclusion: MPAP calculated using the proposed method is as accurate as SPAP calculation and less variable than previous methods, thus allowing widespread clinical use.

Introduction Submaximal exercise testing ( SET) assesses functional exercise capacity in pulmonary arterial hypertension ( PAH) patients and provides additional physiologic information compared with the 6-min walk test (6 MWT). The relative correlations of the 6 MWT and SET using SHAPE-HF™ with other markers of PAH severity, particularly echocardiogram ( ECHO)-derived mean pulmonary artery pressure ( MPAP), have not been investigated. Objectives (i) Examine the correlation between SHAPE measures with the 6-min walk distance (6 MWD), and (ii) Compare SHAPE parameters and the 6 MWD to clinical measures of PAH severity. Methods Fifty-five consecutive group 1 PAH outpatients were evaluated in a single pulmonary hypertension referral center from March 2011 to June 2012. Data collected: World Health Organization ( WHO) functional class ( FC), brain natriuretic peptide ( BNP), ECHO, 6 MWD and SHAPE results. Data are reported using mean ± standard deviation and Spearman correlation coefficients (r). Results Nine patients were excluded. Of the 46 remaining patients, 78% were women and the average age was 61 ± 13 years. PAH characteristics: WHO FC III-IV 48%; idiopathic PAH 52%; BNP 198 ± 277 pg/mL; 6 MWD 399 ± 97 m; ECHO right atrial pressure ( RAP) 7 ± 4, pulmonary artery systolic pressure ( PASP) 63 ± 29 and MPAP 45 ± 17 mmHg. SET with SHAPE results: mean partial pressure of end-tidal ( PET) CO2 31 ± 6 mmHg at end-exercise; ventilatory efficiency ( VE/ VCO2) 43 ± 16. Significant correlations were found between the 6 MWD and SHAPE variables: VE/ VCO2 (r = -0.57, P < 0.0001) and end-exercise PETCO2 (r = 0.42, P = 0.004). VE/ VCO2 correlated with WHO FC, BNP, RAP, MPAP and PASP and 6 MWD only with WHO FC, BNP and PASP. Conclusion SHAPE outperformed 6 MWD in comparison with other measures of PAH disease severity. [ABSTRACT FROM AUTHOR]